Provider Demographics
NPI:1891904157
Name:ISALY, ERIKA LORRAINE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:LORRAINE
Last Name:ISALY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 HEMINGWAY LN
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7520
Mailing Address - Country:US
Mailing Address - Phone:805-654-9115
Mailing Address - Fax:
Practice Address - Street 1:123 W GUTIERREZ ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3424
Practice Address - Country:US
Practice Address - Phone:805-965-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 50957171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF50957OtherMFT REGISTERED INTERN NUM